More Than Just Bone Pain: A Case of Paget’s Disease, Seropositive Rheumatoid Arthritis, and Metabolic Dysfunction-Associated Steatohepatitis (MASH) in a Patient With Elevated Alkaline Phosphatase (ALP)

Paget's disease of bone is a chronic skeletal disorder characterized by disorganized bone remodeling. Although often asymptomatic, it is frequently first detected through elevated alkaline phosphatase (ALP). Given ALP's nonspecific nature, its elevation requires a comprehensive evaluation for hepatic, biliary, and bone pathology. We present a diagnostic challenge involving persistent ALP elevation in a patient ultimately found to have coexisting Paget's disease, metabolic dysfunction-associated steatohepatitis (MASH), and seropositive rheumatoid arthritis (RA).